ERECTILE DYSFUNCTION
LABORATORY WORKUP

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Dr. Chris Steidle - Northeast Indiana Urology

ERECTILE DYSFUNCTION
LABORATORY WORKUP

Laboratory workup of erectile dysfunction should include a number of
evaluations. In our office we typically check a urinalysis. This is
reviewed for presence of glucosuria, sugar in the urine, or
proteinuria, which would indicate either the presence of diabetes or
proteinuria and would be an indicator of chronic renal insufficiency
or chronic renal failure.

As far as serum laboratory investigation, we check a basic chemistry
panel, again, looking for presence or absence of chronic renal
insufficiency or electrolyte abnormalities that could be a
prognosticator of underlying chronic disease, and could easily be the
cause of the erectile dysfunction.

We also focus on the serum glucose. We prefer to do this as a
fasting study, as both the screened and an indicator of diabetes
mellitus.

Testosterone level is also checked. The reason we check a
Testosterone level to evaluate the possibility of hypogonadism. The
effective hormones on sexual functioning again is significant. We do
see a number of patients who have truly low serum Testosterone which
would be an indicator of hypogonadism. When looking for
hypogonadism, or low Testosterone level, we see three basic
syndromes, one is that of hypergonadotrophic, which would be a high
LH and FSA situation. These would be patients who have lost their
testicles, have congenital abnormalities, such as Klinefelter's
syndrome which is a genetic problem, testicular injury from
radiation, drugs, trauma, and aging. We see hypogonadotrophic, which
is a low LH and FSH including congenital syndromes, damage to the
pituitary gland, and a prolactin problem, and we see miscellaneous
problems, such as liver disease, thyroid disease, chronic renal
disease, and diabetes. We also additionally, when we see a
Testosterone level abnormal, add the LH and FSH tests as well.

We certainly have a good profile of the laboratory situation of the
patient prior to recommending androgen therapy. Androgen therapy is
a double-edged sword. It can be very effective in selected cases,
but also it is not without long-term complications, such as liver
disease, elevated cholesterols, the possibility of prostate cancer
and many urologists see this almost on a regular basis. So, our
rhythm for checking Testosterone level would be to check in the
morning and preferably at the same time every day. If we see it at a
normal level, we stop. If we see it low, we then repeat it. If it is
then repeated normal, we then stop, but if it persists low, we then
check both an LH, FSH, which is a leutinizing hormone, and follicular
stimulating hormone, as well as a prolactin. If we see low LH and
FSH with a high prolactin we then check an MRI of the head, thyroid
and adrenal glands, check the internal anatomy of the glandular
system of the body to help us get an accurate diagnosis. If we see
an elevated sugar and we know the patient has diabetes, we also check
a glycosylated hemoglobin. This gives us a feeling for how long the
patient has had the problem with diabetes and will give us prognostic
information as to how well the patient will do with therapy.